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8 Research Gaps
Pages 125-134

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From page 125...
... In its review of studies examining cost-effectiveness of PSH, the committee found that the literature is limited with few randomized controlled studies available, a majority using a quasi-experimental design. Further, the available studies have not been conducted in a manner that is methodologically aligned with generally accepted health care cost-effectiveness research design.
From page 126...
... , and thus no minimum or required set of services has been specified, except case management. Since PSH typically targets individuals with physical and behavioral health problems experiencing chronic homelessness, however, identification of a minimum set of services to be made available on a voluntary basis and specification of key ingredients would seem reasonable, including types of services provided and effective versus ineffective client-to-staffing ratios needed to foster housing retention and housing outcomes.
From page 127...
... . Because assessment tools used in determining housing eligibility emerged from urgency in response to HUD policy, rather than from a series of carefully conducted studies over time, and because the tools are relatively new and not yet subjected to careful research to examine reliability and validity, the base of scientific evidence for existing assessment tools is scant (Levitt, 2015)
From page 128...
... Providers also raised concerns about the availability and adequacy of standardized training on the SPDAT and VI-SPDAT assessment tools to ensure fidelity of implementation within and across evaluators. Another point regarding validity of the assessment tools used in determining access to housing and services is that they were developed for use with adults experiencing chronic homelessness, the population that has received the most focus in efforts thus far to address homelessness through PSH.
From page 129...
... Very little is known about the health impacts of PSH for populations such as youth and families, or about other permanent housing models, including for the majority of persons who experience homelessness but who are not chronically homeless. Health care should aim to reduce disparities in quality and access based on race, ethnicity, age, gender, and other characteristics, and should promote health equity (IOM, 2001; HHS, 2017)
From page 130...
... is whether the housing provided to homeless clients is scattered site or single site. Future studies should account for housing types, models, and service mix to improve understanding of housing impact on health outcomes including for patients with chronic disease, and to ensure that "key ingredients" of PSH can be identified and included in scale-up efforts.
From page 131...
... . USICH reports that this includes efforts to increase the role of mainstream federal programs to assess and track housing status and homelessness, and to provide information to Medicaid agencies, health care providers, and hospitals on assessing homelessness and housing status, such as use of the Z59.0 homelessness diagnostic code in ICD-10 (USICH, 2015c)
From page 132...
... This, in turn, should facilitate better research. BUILDING UNIVERSITY-AGENCY PARTNERSHIPS FOR BETTER DATA AND ANALYSIS Individual agencies providing housing and supportive services to people who are currently experiencing homelessness or have formerly experienced homelessness typically lack sufficient resources for ongoing in-house performance monitoring and evaluation of client outcomes.
From page 133...
... has enhanced innovation and experimentation in using Medicaid dollars to improve health and contain health care costs among Medicaid recipients. Notably relevant to serving individuals experiencing homelessness through state-level managed care organizations is the flexibility in using Medicaid dollars for housing-related costs and "health homes," which support provision of integrated and coordinated primary and behavioral health care for disabled persons experiencing homelessness and other Medicaid recipients.
From page 134...
... Additional randomized controlled trials, when ethically appropriate to undertake, could bolster and refine the evidence of the impact of PSH on health outcomes and health care costs. More partnerships between universities and PSH providers to perform evaluation and monitoring of health outcomes and costs, test innovative financing models for housing and services, and mine health data and homeless management information systems could fill in many of the research and data gaps.


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